Is It Possible To Overdo Medical Care?
Finding a Jewish way to consume medical services within the context of our economic and religious lives
I'm not breaking any new ground when I tell you that Judaism prizes life and health above nearly all other considerations. But I do think it's worth asking whether there are any limits to that priority. Are we, for example, expected to not only invest all reasonable expense and effort in struggling against major illness, but to even push beyond "reasonable"?
To illustrate, it's obviously unreasonable to travel through life with a personal supply of vital organs just in case you need a quick transplant. That seems to make just about as much sense as amputating a healthy limb on the off chance that it might some day become diseased. But what about spending hundreds of thousands of dollars (of other people's money) so delicate surgery can be performed by someone you've heard was better than the guy who does the same thing at your local hospital?
In an ideal world, a world without financial, communal, and spiritual constraints, nothing can hold you back. Sadly, since we don't live in such a world, we’re forced to carefully weigh the potential benefits of expensive choices against their costs. What kind of constraints exist for Torah Jews?
Bitachon
What exactly does it mean to trust God? Children often believe that God always delivers exactly what we want, whenever we want it. If this were true, then making any effort on our own behalf would amount to heresy! But in any case those of us who've lived long enough to have tasted personal disappointment understand that's not how God wants to run His world.
A more mature approach with roots in Tanach and mussar sources describes a God who, because He's all-powerful and all-knowing, is able to interfere whenever He chooses, but only actually does so when it fits His larger plans. The Ramban (Vayikra 26:11), in the context of Assa (II Divrei Hayomim 16:12), distinguishes between the ideal Jewish approach - which relies only on God rather than doctors - and the path for the rest of us who seek and follow standard medical advice.
While giants of bitachon focus just on God, and many simple folk act as though all that matters is natural cause and effect, the middle ground is populated by individuals possessing varying levels of trust. The Ramban's opinion (Beraishis 18:19) is that the greater your trust, the less natural effort ("histadlus") is necessary.
Obviously then, one should strive to minimize ones efforts as much as possible. And, while few if any of us have any business avoiding mainstream medical care, we should nevertheless set ourselves limits.
Budgets
But saving a life is a great mitzvah. Bitachon is important, but shouldn't we be willing to spend all the money in the world for a mitzvah?
Not necessarily. And there are many excellent reasons why that is.
Because there's a limit to how much tzedaka money is available in any one community at any one time. Charitable (and public) funds should be allocated in ways that take into consideration the needs of the larger community.
Because there's often a limit to how much of a particular medical resource is available. Allocating too much to borderline cases in one community might unfairly starve out critical cases in another population. (Although knowing when this might be a problem can get really complicated.)
Because overspending - even when the money is easily available - can have serious unintended consequences. Take Chazal's prohibition on ransoming captives (Kesuvos 52b) as a possible illustration. Out of fear that it might serve to encourage more hostage-taking events - placing pressure on less-wealthy families - redeeming captives for more than their base value was forbidden. The analogy may not be perfect, but it's certainly something to consider.
Avoiding waste
Even if, after thinking through the previous considerations, someone still felt a large medical investment was appropriate, the plan should also make sense from a purely practical perspective.
For instance, are you sure that the benefits of medical travel outweigh the physical strain and emotional costs involved in getting there? How do you actually know that the therapy or surgery you're looking at is qualitatively better than the one available locally?
People often share how "Doctor X is the very best in his field." Such observations are likely based on a positive personal experience, and it is a wonderful way to show gratitude. But it's not exactly an objective measure of a the skills and effectiveness of one medical professional over another.
After all, there are around one million practicing medical doctors in the US alone: finding an unbiased standard with which to distinguish between them can't be easy. And that's especially true when you realize that successful health outcomes depend on far more than just a doctor's skill: the availability of expensive equipment, technicians able to maintain and use it, nursing staff, and even site cleaning crews also play significant roles. And that's besides the deep scientific knowledge you'd need to properly choose between competing therapy tracks. Assessing all those variables and coming to a clear and practical conclusion is hard.
None of this is to suggest that objective assessments are impossible. But they're probably difficult and rare enough that a healthy dose of skepticism should accompany the decision-making process.
Finally, and sadly, there will be times when Judaism's health imperative may not require any more effort from us. As we approach end of life, even protocols like do-not-resuscitate directives can be permitted and even preferred (see Kesuvos 104a concerning the maidservant of Rabbi Yehuda HaNasi). Deciding when to stop pushing is painful and complicated and, of course, often something requiring serious rabbinic involvement. But it, too, should be part of the discussion.